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ZONING PERMIT NO. Page 1 of 2 <br /> DANE COUNTY SHORELAND ZONING PERMIT DCPSHL-2017-00088 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> HAPPY VALLEY ADDITION LLC DUREN CUSTOM HOMES (608) 837-4750 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 3564 EGRE RD 3027 CASTLETON CROSSING <br /> (City,State,Zip) (City,State,Zip) <br /> DEFOREST, WI 53532 SUN PRAIRIE, WI 53590 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> DSDUREN @CHARTER.NET <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0911-302-0518-0 TOWN OF BRISTOL 30 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 6820 KAROLINA WAY <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 28 HAPPY VALLEY ADDN TO BRISTOL GARDENS <br /> ZONING DISTRICT PARCEL SQ FOOTAGE PROPOSED PROJECT: New Structure/Addition <br /> A-1 Agriculture 27386 Description:SFR <br /> 5 n ry .� <br /> District m <br /> PROJECT INFORMATION App for a Residential Structure; SEWER <br /> Septic <br /> REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION £ ` <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND . <br /> YES ❑ NO 0 YES ® NO 0 YES ® NO <br /> Existing Impervious Proposed Impervious - -- <br /> Sq.Ft.0 Sq.Ft.5089 € € fh <br /> Setback from Ordinary High Water Mark Water Body Name <br /> 150 TOKEN CREEK PERMIT FEE <br /> $150.00 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of this permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for complying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be <br /> difficult to identify. Failure to comply may result in removal or modification of construction that violates <br /> the law or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SI NATURE: Ow -r/Agent DATE: <br /> Ordinances.Any unauthorized change from the information or j <br /> plans submitted will invalidate the permit. ■ LLc <br /> OFFICE USE ONLY (form version 01.01.00) <br /> DATE ISSUED INITIALS INSPECTION DATE INITIALS <br /> 11/15/2017 HJH3 <br /> DATE REVIEWED INITIALS <br />